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First Time IRN Service Request

We will use this information only to set you up as a customer of IRN services. All information will be treated as confidential; no information will be shared outside of IRN. Providing this information does not obligate you to use IRN services.

Customer information

Your name:
Title:
Organization:
Phone:
Email:
Address:
Address 2:
City:
State:
Zip:

Most common contact and location for pickups (if different, otherwise “Same”)

Pickup contact:
Phone:
Email:
Address:
Address 2:
City:
State:
Zip:
Does the pickup location have a loading dock?

Accounting contact (if different, otherwise “Same”)

Name:
Title:
Phone:
Email:
Address:
Address 2:
City:
State:
Zip:
Is a Purchase Order required for each pickup?

What materials do you recycle now?

Check all that apply

Mixed paper
White paper
Cardboard
Confidential documents
Bottles/Cans
Kitchen containers
Computers, Monitors, Other electronics
Fluorescent lamps
Other lighting
Batteries
Handheld electronics containing batteries
Appliances
Scrap metal
Surplus furniture
Pallets

Fields in bold are required.
	IRN values your privacy. We do not sell, rent, or give your information to anyone.

IRN | 7 South State Street | Concord, NH 03301 | 603.229.1962 | fax 603.229.1960 | mail[at]ir-network.com